Hi
through the wonderful information on this forum - -Thank you - I’ve managed to reduce pramipexole from 3 * 0.08 tablets down to 0.5 of a 0.08 tablet a night using iron every 2nd day. . I’ve also used 50mg Tramadol when symptoms were bad when reducing dose.
My question is at what point do I move over to Gabapentin? Do I wait until I have no pramipexole use?
Any advice appreciated .
Clare
You can start it now.There are two schools of thought.
Dr Earley at Johns Hopkins University believes patients should reduce without ANY help and spend 2 weeks completely med free so the base level can be attained. But that's really tough for most people.
The other method is to start gabapentin around a month before the last dose of Pramipexole.
Starting at 300mg and increasing slowly by 100mg every few days up to 900mg. Take in split doses of 300mg and 600mg 2 hour's apart in the evening. You can increase the dose up to the average 1200-1500mg to cover symptoms. But split the doses so you take no more than 600mg in one dose.
It can take a few months for withdrawal symptoms to settle.
The beginning dose is usually 300 mg gabapentin. If you are over 65 and susceptible to falls the beginning dose is 100 mg. Start it 3 weeks before you are off pramipexole since it takes 3 weeks to be fully effective although it won't be fully effective until you are off pramipexole for several weeks. After that increase it by 100 mg every couple of days until you find the dose that works for you. Take it 1-2 hours before bedtime as the peak plasma level is 2 hours. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. Most of the side effects will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. If you take magnesium even in a multivitamin, take it at least 3 hours before or after taking gabapentin as it will interfere with the absorption of gabapentin and if you take calcium don't take it within 2 hours for the same reason . According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin ."
Again, thank you. It really is wonderful to have this freely given information to help us to make better choices in life 😊
I’m pretty sure you could start Gabapentin now, I switched form pramipexole few years ago, you’re in such a tiny dose now I’m sure you could stop it and start gabapentin.
and personally I would never go back onto pramioxole.
Hi After years of symptoms I have found a combination of meds that work I am on maximum dose of gabapentin 1200 three times a day Roprinirol 1 mg at 1pm and 3 mgs at night l plus 10 mg amitriptyline I also take 10 mgs of nitrazepam for a mental health issue since I started this combination my symptoms have been controlled I think this happened by accident due to other medical issues but it works
You are on the maximum amount of ropinirole at 4 mg. If you are taking it in the daytime, you are probably suffering augmentation. The signs of augmentation are when you have to keep increasing your dose to get relief, or when your symptoms occur earlier in the day or there is a shorter period of rest or inactivity before symptoms start or when they move to other parts of your body (arms, trunk or face) or when the intensity of your symptoms worsen. RLS generally only occurs at night.
Even if you are not suffering from augmentation now, Up to 70% of people will eventually suffer augmentation according to the Mayo Clinic Updated Algorithm on RLS which believe me you don't want because it can be hell to come off it and the longer you are on it, the harder it will be to come off it and the more likely your dopamine receptors will be damaged so that the now first line treatment for RLS gabapentin or pregabalin won't work. And one expert believes everyone will eventually suffer augmentation. Check out the Mayo Clinic Updated Algorithm on RLS which discusses augmentation and the latest guidelines on RLS treatment. Https://mayoclinicproceedings.org/a...
Plus you are wasting taking gabapentin since it doesn't work very well while you are on a dopamine agonist. If you decide to come off gabapentin you need to do so very slowly to avoid withdrawal effects. Reduce by 100 - 200 mg every 2 weeks. If you do so you will have no withdrawal effects.
Amitriptyline makes RLS worse for most. The only safe antidepressants are wellbutrin and trazodone.
Have you had your ferritin checked? If so, what was it? This is the first thing your doctor should have done.Improving your ferritin to 100 or more helps 60% of people with RLS and in some cases completely eliminates their symptoms. If not when you see your doctor ask for a full iron panel. Stop taking any iron supplements including in a multivitamin that has iron in it 48 hours before the test, don't eat a heavy meat meal the night before, fast after midnight and have your test in the morning before 9 am if possible. When you get the results, ask for your ferritin and transferrin saturation (TSAT) numbers. You want your transferrin saturation to be over 20% but less than 45% and your ferritin to be at least 100. If they are not, post them here and we can give you some advice.
Meanwhile some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, artificial sweeteners, carbs, foods high in sodium(salt), foods that cause inflammation, ice cream, eating late at night, oestrogen (estrogen) including HRT, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, fennel, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, CBD, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, vibration devices like therapulse, using a standing desk, listening to music, meditation and yoga. Keep a food diary to see if any food make your RLS worse.
Many medicines and OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.
Dear Goagal, I normally ask my brilliant GP to help you me regarding the medication. I hope this is helpful for you.Kind regards, Hollygreen 🙂
Thanks Holly Green Ive made an appointment to speak with her
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